Most people who find this page have already been somewhere else first. You have had bloodwork. Possibly a nerve conduction study. You were told the results were normal, or that your neuropathy is idiopathic, and that you should manage the symptoms.
That is a frustrating place to be, and it is where a lot of neuropathy evaluations stop rather than start.
This page explains how we approach peripheral neuropathy at our Oklahoma City clinic, what an evaluation actually looks at, and — just as importantly — what we do not claim to do.
What “idiopathic” usually means
Idiopathic means no cause was identified. It does not mean no cause exists.
In practice the label is often applied after a limited workup — a basic metabolic panel, a B12 level, an A1c, and a nerve conduction study. Those are reasonable first steps. They are not a complete search, and several of the more common contributors to peripheral neuropathy will not show up on any of them.
Two examples that come up constantly:
- A serum B12 in the normal range does not rule out functional B12 deficiency. Methylmalonic acid is the more sensitive marker, and it is frequently never ordered.
- Nerve conduction studies and EMG measure large nerve fibers. Small fiber neuropathy, by definition, affects the thin fibers those tests do not assess — so a normal EMG is entirely compatible with significant small fiber involvement.
A normal test is information about that test. It is not always information about your nerves.
Diabetic neuropathy — the most common cause, and what still gets missed
Diabetes is the single most common cause of peripheral neuropathy, and if you have diabetes it is reasonable for it to be the leading explanation. But two things are worth understanding.
First, nerve injury often begins before diabetes is diagnosed. Peripheral neuropathy is documented in prediabetes and impaired glucose tolerance, which means a normal fasting glucose and a borderline A1c do not exclude a glycemic contribution. Post-prandial glucose patterns and insulin resistance markers give a fuller picture than a single fasting number.
Second, having diabetes does not mean diabetes is the only thing happening. This is the more consequential point. Once a patient has a diabetes diagnosis, additional contributors frequently stop being looked for — B12 status, thyroid function, kidney function, autoimmune markers, alcohol history, medication effects. A person can have diabetic neuropathy and a second, separately treatable contributor at the same time, and the second one gets attributed to the first.
An evaluation that stops at “you have diabetes, this is diabetic neuropathy” is a reasonable conclusion that has not been tested.
When it is not diabetes
A substantial share of peripheral neuropathy is not diabetic. Contributors we work through include:
- Nutritional — B12 and functional B12 status, B6 (both deficiency and excess), folate, copper
- Metabolic — thyroid function, kidney function, glucose handling short of diabetes
- Autoimmune and inflammatory — including neuropathy associated with Sjögren’s, celiac disease, and other autoimmune conditions
- Post-infectious and post-viral — including small fiber neuropathy following COVID-19 and other viral illnesses
- Toxic — alcohol, certain medications, occupational and environmental exposures
- Chemotherapy-related — nerve symptoms that began during or after cancer treatment
- Vascular — circulation-related contributors to nerve symptoms
Not all of these are reversible. Some are. Knowing which category you are in changes what is reasonable to expect, and that is worth establishing before anyone starts treating anything.
Small fiber neuropathy
Small fiber neuropathy deserves its own mention because it is the most common reason someone is told their tests are normal while their symptoms are clearly real.
Burning, electrical, or prickling pain — often worst at night, often starting in the feet — with normal nerve conduction studies is a recognisable pattern. Small fiber involvement is also common in dysautonomia, POTS, mast cell activation syndrome, hypermobile Ehlers-Danlos syndrome, and post-viral illness, which are conditions we see regularly.
What an evaluation here involves
An evaluation is a structured search for contributors: a detailed history including symptom pattern, onset and progression; review of testing already performed, including results that were called normal; and additional testing where the history points somewhere the prior workup did not go.
The goal of the first visit is not to start a treatment. It is to determine whether there is an identifiable driver of your nerve symptoms that has not yet been found, and to tell you honestly what we think.
What we do not claim
You will find clinics in Oklahoma City advertising neuropathy programs with success rates and reversal claims. We do not make those claims, and we would encourage caution about anyone who does.
- We do not promise reversal, and no honest clinic can
- We do not quote success rates, because the research that would support a number does not exist
- Not everyone who contacts us is someone we can help, and we will tell you when that is the case
- We do not bill insurance
Venturis Clinic is a cash-pay practice. Dr. Philipose holds a Doctor of Chiropractic and ICCP credential; he is not a medical doctor, and this practice does not replace care from your prescribing provider.
Serving the Oklahoma City metro
Our clinic is on N. May Avenue in Oklahoma City, and we see patients from across the metro — Edmond, Yukon, Norman, Moore, Midwest City, Bethany, Warr Acres, Nichols Hills, Mustang and Piedmont — as well as from further out in Oklahoma.
Common questions
My EMG was normal but I still have nerve pain. What does that mean?
EMG and nerve conduction studies assess large nerve fibers. They do not assess small fibers. A normal study rules out certain large-fiber problems; it does not rule out small fiber neuropathy, which is a common cause of burning or electrical pain with normal conventional testing.
My B12 was normal. Can B12 still be involved?
Yes. Serum B12 can sit within the reference range while B12 is functionally insufficient at the tissue level. Methylmalonic acid is a more sensitive marker of functional B12 status and is often not ordered as part of an initial workup.
I have diabetes. Is there any point looking further?
Often, yes. Diabetes being present does not establish that it is the only contributor. B12 status, thyroid and kidney function, autoimmune markers, medications and alcohol history can all contribute alongside diabetes, and are commonly not reassessed once a diabetes diagnosis is on the chart.
Can neuropathy be reversed?
It depends entirely on the cause and how long it has been present. Some contributors are correctable and some nerve damage is permanent. Anyone answering this question without knowing your cause is guessing, and anyone attaching a percentage to it is doing something worse.
Do you take insurance?
No. Venturis Clinic does not bill insurance.
Starting
If you want to find out whether an evaluation here makes sense for your situation, the first step is a short phone conversation rather than an appointment.
Request a free neuropathy phone consultation — about fifteen minutes, and you get a straight answer within one business day, including if that answer is that we are not the right fit.
You may also want to read what the evidence actually says about light therapy for nerve pain, which covers a category of treatment heavily advertised for neuropathy and what the research does and does not support.
Reviewed by Alvin Philipose, DC, ICCP · 23 August 2026. This page is for informational purposes only and does not constitute medical advice. Individual results vary and no outcome is guaranteed. If you are experiencing sudden weakness, difficulty breathing or swallowing, new bowel or bladder changes, or a wound or infection on your foot, seek emergency care.